National Urban Health Mission for the urban poor!

USHAs to deliver healthcare to urban poor!

Urban India shall soon have a dedicated public health delivery system on the lines of National Rural Health Mission launched in 2005 to address the health challenges of rural areas.The much-awaited National Urban Health Mission (NUHM) will be launched in the next three months to specifically meet the health needs of urban poor, Health Ministry sources said.

The Mission is expected to cover cities and towns having population of over 50,000 people. This would come to around 779 cities including Mumbai, New Delhi, Kolkata, Chennai, Bengaluru, Hyderabad and Ahmedabad.

Health Ministry officials said the revised EFC note for the Mission had been prepared after the Planning Commission suggested the possibility of extending NRHM to urban areas.

“But that was not feasible because the health delivery demands of rural and urban areas are very different. So we are preparing a new note for approval. This addresses the Planning Commission concerns,” the sources said.

The NUHM which envisages USHAs (Urban Social Health Activists on the lines of ASHAs in villages) is important considering urban population is the fastest growing segment of India’s population.

Provisional Census 2011 data showed that for the first time since Independence, the absolute increase in population was more in urban areas that in rural areas. At present, rural population in India is 68.84 per cent (down from 72.19 per cent in 2001 Census) as against 31.16 per cent urban population.

Of the 370 million urban dwellers, over 100 million are estimated to live in slums and face multiple health challenges on the fronts of sanitation, communicable and non communicable diseases.

NUHM seeks to improve the health status particularly of slum dwellers and other disadvantaged sections by ensuring equitable access to quality health care through a revamped public health system.

The main features of the Mission include city-specific planning based on the spatial mapping of slums and slum-like habitations to cover urban poor and use of the available resources and partnering with private providers to fill public health delivery gaps.

The Mission envisages USHAs and Mahila Arogya Samitis to improve access of urban poor to public and private health services.

But, will the USHAs bring in the necessary ‘change’ for urban slums? A study based on survey of the urban slums in Mumbai.  published on July 3 in PLoS Medicine, conducted a trial to see whether women’s groups and female health workers in urban slums have any impact on reducing maternal and infant deaths in their communities. Their findings show an insignificant reduction in the health indicators in the estimated population of 2,83,000 they covered in two years. For instance, 20 maternal deaths were reported among the groups assisted by healthcare workers against 24 reported from groups that received no such attention.

“In an urban slum, bundling of strategy is needed to improve health indicators. Women groups alone cannot bring a change,” said Neena Shah More of Society for Nutrition, Education and Health Action (SNEHA), a non-profit based in Mumbai.

Shah, who is also an author of the study, observed during the trial that women in urban slums do not interact with other women much because they are too busy working and they have small houses. “So, the basket of healthcare services for each of them should be different. Say, healthcare services for some may be provided at the doorstep,” she said. The authors also saw that many women drop out of community initiatives and stop attending meetings when they feel they have learned enough.

The trial examined a range of outcomes, including stillbirth, neonatal mortality rates, antenatal, intrapartum and postpartum care. They found no difference in the uptake of antenatal care, reported work (during pregnancy), rest and diet in later pregnancy, institutional delivery, early and exclusive breastfeeding, or care-seeking for maternal or neonatal problems between groups assisted by women workers and groups which received no assistance.

The occurrence of serious antenatal symptoms (premature rupture of membrane, antepartum haemorrhage, cessation of fetal movements, or maternal seizures) was less common in the groups where intervention was made. The difference in stillbirth rate and neonatal mortality rate was insignificant in both groups.

The authors say that the reason for this insignificant change in the health care indicators is probably because of some external interventions. Over the trial period, the condition of the slums improved, note the authors. “Gutters were covered, sanitation block coverage increased, housing fabric became more durable, and there was widespread electricity supply,” write the authors.

The women of the slums, however, admit that peer learning helped in changing behaviour and increased their knowledge about health services and rights. “The level of awareness on healthcare needs and rights in an urban slum is low. Most of the families living in urban slums are migrants and may not be registered with healthcare schemes in the cities. So, healthcare workers can guide them and help them increase their knowledge, awareness and can change their health care seeking behaviour,” said Seema Gupta, regional director for reproductive and child health with Voluntary Health Association of India, a non-profit. She stressed the need for women health workers in urban settings. 

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